HomeMy WebLinkAboutMortgage_Pinkston (2) fw_ . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�1� FOR DEDUCTION FROM ASSESSED VA eeyy'TTIO
°"ti. State Form 43709 rtm/6-09) � D
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
II�t1 rf11�l�� Form Ned with:
M be filed in person or by mail with the County Auditor or County Recorded e/rbe5toungi are the property is located.
Filing Dates: f) Real Properly.Must file during the year for which the deduction is sought. NE County Auditor
2) Mobile/Manufactured Homes not assessed as Real P y.Must file du'rig th eWe(12)months
before March 31 of each year the deductions sought /'/{ County Recorder
See reverse side for additional instructions and qualifcat'.� GIRSON COUNTY AUDITOR
Applicant(owner or con�ns an�-
T D' Key number,/ esm�p1'(�' , i• Tony!
Page number
,�� all —011—� pa-wo kCJO o�0 ` � a4 1 !
Assessed value of real property as of tract indebtedness unpaid as of Mortgage l Contract indebtedness unpaid as of Is the apparent the sole
Mardi 1,current year Ma SL/L/V date of appII tion legal or equitable Amer?
If no,what is his/her exact share of interest? ` / If owned with someone other than ❑ Yes ❑ No
spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the
property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-T)
Name of mortgagee or contract seller W
Address of mortgagee or contact seller(number and street city,ate.and ZIP code)
a0I J...... I
Drawer NO.......•
e)
/ rat county? • What Taxing District? Has this deduction been requested on property
.............
for current year? ❑ Yes ❑ No
Card 1St c,to
COUNTY AUDITOR
Deduction approved In the amount of',
20 20 20 20 20 20 20
Signature of itor ' //J County Date(month,day,year)
I/We certify under the penalty of of perjury above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
n._(owner's frf name Date(month,day,year)
i � �TQ \ t\ tI i 41 pav -#0 — k0c0
Person authorized by duly executed Power of Attorney or by IC 6-L1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .